A cut in the windpipe (tracheotomy) is a surgery-created access to the trachea. This as a tracheostomy hole is always needed if the supply of oxygen to a patient must be secured by artificial respiration. You can read the Following situations in which a tracheostomy is needed, how the procedure is performed, and what opportunities and risks can be associated with such a procedure.
Erroneous way is also colloquially called the Kiniotomie as a tracheotomy. The surgery is an emergency medical air tube puncture, aimed at Opening the Airways in the level of the larynx. Other than the tracheotomy, not the air tube, but only the membrane between the cricoid and thyroid cartilage cut through, in order to secure the breathing of the patient is in a Kiniotomie.
Why is a tracheotomy? – The purpose of a tracheostomy
The medical term for a cut in the windpipe “tracheotomy” is derived from the ancient Greek words trachýs (τραχύς) for ‘rough’, and tomē (τομή) for ‘cut’. The tracheotomy is performed through outer layers of tissue and must penetrate to the trachea (Trachea), the access to the lungs. The creation of a tracheostomy can then be used for artificial respiration of a patient.
The first air tube holes were already made in ancient Egypt. In the middle ages, small tubes, which should secure the cut opening came in the tracheotomy finally, for the first time. Even today, the air tube special Tracheal or respiratory cannula (tube) made of plastic or metal applied, which stabilize the tracheostomy and artificial ventilation of the patient easier.
The reasons for a tracheostomy may be vary from case to case. Generally, the trachea is cut, but always essential, if the trachea of a patient is severely narrowed or completely blocked. The reason for such a problem can be:
- Tumor diseases
for example, in the nose and throat
- Injuries of the respiratory tract
for example, after an accident injury in the mid-face, neck, or throat
- Swelling of the respiratory tract
for example, in the case of strong allergic reactions or inflammation of the mouth and throat
- Foreign body aspiration
for example, due to swallowed foreign body in the trachea
- other causes
for example, chronic respiratory weakness, coma, Respiratory abnormalities, or paralysis of the larynx
Trivia: A tracheotomy is significantly gentler than Intubation. The latter carries the risk of injury to the vocal cords and the larynx when the tube is inserted into the neck. A tracheostomy is the patient and also more enjoyable, eating and Talking independently is possible and the respiratory cannulas auslöen no such unpleasant foreign body sensation, as it is, for example, when intubation own tube of the case.
What is a tracheotomy?
As already explained, is no longer used for a tracheotomy if the Patient is self-breathing capable, or airway to narrow, make it difficult to breathe. In rare cases, a tracheotomy can also be employed in emergency situations for the application of, for example, if due to an accident is an injury of the larynx or the trachea is swollen due to an allergic shock. Regardless of the cause, an air tube is carried out planned, but always under General anesthesia of the patient. The procedure is as follows:
- Step disinfection and patient positioning: To disinfected the beginning of the surgeon in front of the trachea cut the neck of the patient. Surrounding areas are covered with sterile cloths. In addition, the Patient for the procedure in the supine position, the neck must be hyperextended to the rear.
- Step – the opening of the trachea: after the preparatory actions, a scalpel is set below the so-called tracheal rings (cartilagines tracheales). It is a vertical incision of approximately 3 cm in length. The incision through the skin and the underlying tissue penetrates. Next, the surgeon works through the neck muscles to the trachea. Now and again, a partial is due to separation of the thyroid gland.
- Step – up to the introduction of the Tracheostomy tube In the trachea incision resulting tracheostomy is the Tracheostomy tube. The tube holds open the air tube access and allows for a direct supply of air into the lungs. It is absolutely important, both when cutting and when the Tracheostomy tube, to be careful not to damage any surrounding blood vessels or nerves.
- Step – fixation of the cannula After completion of the trachea section of the used tube is fixed finally. If the cannula is only to remain for a short time in the trachea, this is usually with a collar. In the case of long, artificial respiration (e.g. in the case of comatose patients), persistent fixation, however, with seams that ensure permanent ventilation, a secure Position of the tube and the slipping prevent. A separate treatment is a tracheotomy necessary.
Opportunities and risks of a tracheotomy
- A tracheostomy is a surgical intervention which carries within its sequence, hardly any risks. Since the air tube is access below the tracheal rings, is usually not a cartilage tissue is removed and the thyroid gland is not permanently damaged. For people with acute or chronic shortness of breath or difficulty breathing, the trachea is cut, so a minimally invasive method, the oxygen supply to the body. For people who would be due to a serious accident in a coma and without artificial respiration die, it means a tracheotomy the only chance of Survival.
- In principle, the risk of injury to the carotid arteries, which run immediately adjacent to the trachea in case of improper execution. Similarly, the risk controls of a transection of the Nervus Recurrens, which extends to the trachea and the vocal cords. A tracheoesophageal fistula due to incorrect Puncturing of the trachea and esophagus could occur today, but medically well-treated.
- Not sufficient fixed respiratory cannulae can be displaced by movements of the patient. This can lead to values of a complicated air supply and an oxygen supply. The same is true for clogging of the cannula, what happens in patients is commonly due to saliva accumulation in the tube in case of inadequate Aspiration of saliva.
- After the treatment, air does not flow through the mouth or nose, but through the cannula into the lung. This limits the sense of taste and smell of the patients, of course, strong. In addition, the cannula can constrict the larynx and thereby make Swallowing difficult. Furthermore, it can cave in as a result of incorrectly introduced tracheal cannula to accumulation of Air in the mediastinum area, the chest and the Pleural space. This can put pressure on the lungs and need to be treated by a physician.
- The tracheostomy can occur due to impurities in inflammation and wound infections. Similarly, the formation of blood effusions are possible. The cut opening must, therefore, during, and after the use of the tracheostomy to the ventilator as sterile as possible.
The tracheotomy is an important surgical procedure, which ensures a continuous oxygen supply to respiration-incompetent patients. Since the cut is only a few centimeters, and as gently as possible is carried out, count de tracheostomy today to the minimally invasive operations. Nevertheless, it can remain after the opening of the trachea, a permanent scar. The possible complications of a tracheotomy, however, and occur generally only rare if the procedure is carefully and under sterile conditions.